Failing Health Care Co-ops Will Cost Taxpayers

Consumer Operated and Oriented Plan Programs (COOPs) were really a political compromise between Members of Congress who wanted a public plan option and those who didn’t. Once the Affordable Care Act passed, COOPs had outlived their usefulness. However, they are now failing and will cost taxpayers plenty. Senior Fellow Devon Herrick testified before a congressional committee.

Major Findings State-By-State

"53,642 foster children were legally free for adoption at the start of fiscal 1997."

The federal government acknowledged 17 years ago that accurate tracking data on children in substitute care would be important in addressing the particularities of the system, but its mandates for information have largely gone unfulfilled. Many states could not easily report basic, broad details about their foster care caseloads. Some of the most important statistics are largely uknown - like the number of children who have had their biological parents' rights terminated and are legally free to be adopted. Today, most national estimates fall well below the mark of the true number of children who need homes. President Clinton's Adoption 2002 plan calls for 54,000 adoptions from foster care in the year 2002 - a goal that is barely adequate to meet the need for homes for children who are parentless and legally free to be adopted today. Recognizing that policymakers and the public did not have this basic information on child welfare, the Institute for Children, over a two-year period, gathered, updated and confirmed data for each state and the District of Columbia. [See the Sidebar on Methodology of the State-by-State Study.]

As shown in Table I, the Institute found that:

At the close of fiscal 1996, 526,112 children were in state-run substitute care.

More than half of these children were concentrated in seven states.

Based on written documentation from 47 states, 53,642 foster children were legally free for adoption.

The actual number of legally free children was higher, since Connecticut and Montana reported that the number was "not available" and Arizona and the District of Columbia left the survey question blank.

22,491 foster child adoptions were finalized in 47 states in fiscal 1996.

Because the foster care population is constantly in flux, the numbers reported here are changing daily. Some of the children reported as free to be adopted at the end of 1996 were already in pre-adoptive homes; others have since been adopted. In the meantime, newly freed-for-adoption children have joined the ranks of foster children who wait for permanent families. The Institute for Children asked the states to provide a breakdown of the status of children who were legally free to be adopted. Many were already in pre-adoptive homes, but for a significant number of others, adoption was not a goal, despite the fact that their biological parents' rights had been terminated. Figures II, III and IV show the status of TPR children in three diverse states: Maine, California and Wisconsin.

No effort was being made to place for adoption 20 percent of the free-to-be-adopted children in Maine and 15 percent in California.42

By contrast, only 4 percent of free-to-be-adopted children were in long-term foster care or an Independent Living Program in Wisconsin.

As Table I shows, nationwide, eight of every 1,000 children were in substitute care at the end of fiscal 1996. In some states, the prevalence of foster care placement was much higher than the national average. In Illinois, it was 17 of every 1,000; Colorado and Minnesota reported that 14 of every 1,000 children were in foster care; and the District of Columbia, reporting for 1995, had a prevalence rate of 22, almost three times the national average. Interestingly, substitute care prevalence rates do not seem to be predicated on the size of the state's total child population or by the presence of large urban centers. Included among the 10 states with the highest prevalence rates were California, New York and Illinois, which have extremely large child populations. Also included among the 10 jurisdictions with the highest prevalence rates were North Dakota, Vermont and the District of Columbia, which have very small child populations. Rural states (Oregon, Alaska) were just as likely to have high prevalence rates as jurisdictions with large urban centers (New York, District of Columbia).

More than twice as many children were legally free to be adopted at the beginning of fiscal 1997 as were adopted in all of fiscal 1996. The six states with the highest numbers of adoptions in 1996 all began the 1997 fiscal year with greater numbers of free-to-be-adopted foster children still needing adoptive placements than the total placed during the prior year. For example, Ohio finalized 1,201 adoptions during 1996, but began the new fiscal year with another 3,588 foster children legally free for adoption. [See Figure V.]

Methodology of the State-By-State Study

To conduct its two-year study of public agency child welfare, the Institute for Children (IFC) designed a survey template that could be used for all 50 states and that addressed a number of critical questions about child welfare. IFC researchers then identified the most appropriate recipient ("contact person") for the survey within each state's child welfare agency. Surveys were sent to the contact person in each state, and the IFC subsequently contacted every state and secured updates and verification. Many states were initially reluctant to divulge information and other had difficulty synthesizing the requested data. Some states were unable to procure certain figures, leaving sections or individual questions blank or marked "NA." However, upon completion of the study, written verification on key questions was secured from all 50 states.

States' tracking methods and fiscal years vary. Therefore the statistics reflected in this report are limited to what states could provide in writing and within the study deadlines. Furthermore, the number of children in care changes daily; the figures reflected here were the most current available upon completion of the study in May 1997.

States' procedures for termination of parental rights also vary. Most states petition for legally freeing a child for adoption when it becomes clear that he can never return to his biological family. However, a few states will not file a petition or consider a child free to be adopted until an adoptive placement has been found. This practice leads to slow transitions from foster care to adoption. Thus the number of children legally free for adoption as indicated by the states and cited in this report is likely lower than the number of children who will soon need an adoptive home and who could be considered ready to be adopted.

States had difficulty supplying data. Thirty-one states changed contact persons during the two-year study. The District of Columbia was unable to provide any data for 1996; all calls and faxes during 1997 went unanswered. Four of the states with the highest prevalence rates could not identify the number of free-to-be-adopted children for whom the state was actively seeking an adoptive home. North Carolina's figure for finalized adoptions is not reliable as it includes adoptions finalized in previous years. New York, with the highest number of foster children legally free for adoption, could not provide the number of 1996 finalized adoptions. South Dakota does not keep records on the number of children whose adoptions were finalized in the last fiscal year; the same is true for Tennessee. Contacts in several states indicated that they did not have reporting systems in place that would provide all the data requested by the IFC, which was far less comprehensive than the data required by the federal government.